Less than 10% of Medicaid patients with lupus vaccinated against preventable disease
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Less than 10% of Medicaid beneficiaries with systemic lupus erythematosus are vaccinated against preventable diseases such as influenza, herpes zoster, cervical cancer and others, according to data published in Arthritis Care & Research.
“Prior studies among individuals with SLE have demonstrated high rates of serious infection and substantial associated mortality,” Candace H. Feldman, MD, ScD, of Brigham and Women’s Hospital, in Boston, and colleagues wrote. “Rates of hospitalization for herpes zoster in this population are especially high and may be rising. In addition, individuals with SLE and other systemic rheumatic diseases may be at higher risk for high-grade cervical dysplasia and cervical cancer compared to the general population, which may be in part related to persistence of human papillomavirus infection.”
“In general, vaccinations for these conditions have been found to be both safe and efficacious among individuals with SLE,” they added. “While decreased immunogenicity has been suggested at times in the setting of immunosuppressive use, in most cases, the vaccines still appear to be efficacious. Despite this, influenza, pneumococcal and human papillomavirus vaccination rates among individuals with systemic rheumatic diseases remain suboptimal.”
To analyze the use of acute care for vaccine-preventable diseases, and its sociodemographic contributors and predictors among patients with SLE, Feldman and colleagues studied Medicaid claims data from 29 states from 2000 to 2010. The researchers included a total of 45,654 adult beneficiaries with prevalent SLE and 12 months of enrollment prior to their first lupus code.
The median age among the included patients was 41 years, and 93% were women. In addition, 40% were Black, 38% were white, 16% were Hispanic, 3% were Asian and 1% were American Indian or an Alaska Native, while 3% reported being more than one race. Regarding geographic distribution, 20% of included beneficiaries hailed from the Midwest, 21% were from the Northeast, 38% came from the South and 21% were from the West.
The researchers identified the use of acute care through ED or hospital discharge diagnoses, and defined vaccine-preventable disease as influenza, pneumococcal disease, meningococcal disease, herpes zoster, high-grade cervical dysplasia, cervical cancer or hepatitis B. Using this data, they searched for examples of acute care use for vaccine-preventable disease following patients’ first SLE code, using Cox regression to calculate risk based on sociodemographic factors and health care use, adjusting for vaccinations, comorbidities and medication.
According to the researchers, less than 10% of included beneficiaries received vaccinations. The highest inoculation rate — 7.2% per year — was for the influenza vaccine, while all the other vaccines failed to reach 3% during the 12-month period. In all, there were 1,290 patients with at least one emergency department visit or hospitalization for a vaccine-preventable illness, for a rate of 6.6 per 1,000 person-years, with 93% of cases occurring in those who were unvaccinated. The risk for acute care use for vaccine-preventable disease was 22% higher among Black patients compared with whites (HR = 1.22; 95% CI, 1.06-1.39).
In addition, those with more outpatient visits demonstrated a lower risk for acute care use for vaccine-preventable disease, with a hazard ratio of 0.74 (95% CI, 0.61-0.91) for 6 to 10 visits compared with none, and 0.67 (95% CI, 0.55-0.82) for more than 10 visits compare with none.
“Between 2000 to 2010, we identified 1,290 patients who utilized acute care for vaccine-preventable illnesses, 93% of which occurred among patients without prior billing codes for related vaccinations,” Feldman told Healio Rheumatology. “We also found that patients who were Black had a 22% higher risk of acute care use for these illnesses compared to individuals who were white.”
“Greater outpatient use was associated with significantly lower risk,” she added. “These episodes demonstrate potentially missed opportunities, particularly among vulnerable populations, to deliver high quality outpatient, preventive care, and provide impetus for further interventions to address this.”
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